Clinical Member Advocate

The Role: You're a clinician who understands that great care coordination doesn't happen by accident; it happens through relentless follow-through, clear communication, and someone who refuses to let things fall through the cracks. At Nara, you'll help own the clinical experience for our members: guiding them through serious illness, managing complex cases, reviewing prior authorizations, and serving as the clinical expert our member support team escalates to. You'll also be on phone rotation yourself, taking real calls from members and providers about coverage questions, network lookups, claims status, and care navigation. This isn't a case management role at a large health system where your hands are tied by rigid protocols. You'll have real authority to advocate, coordinate, and elevate and you'll do it inside a small, fast-moving team where your work directly shapes how we build and operate. Most of your time is clinical: PA review, care coordination, UM, and complex member outreach. But this role includes a genuine member support component - you'll be on phone rotation alongside the support team, fielding inbound calls from both members and providers. Those calls won't always be clinically complex, and that's expected. You're a backup for the support queue, not just a clinical escalation path. A typical Tuesday: A member with a new cancer diagnosis calls overwhelmed - they don't know what's covered, where to go, or what to do next. You review the plan, confirm the oncologist is in-network, identify the pending PA for chemo and push it through, coordinate with the specialty pharmacy as needed, and follow up with the member to walk them through next steps. You document everything in real time. A week later, you're the one checking back in.

Key Responsibilities: Clinical Operations (70%)Review prior authorization requests against evidence-based clinical criteria and plan design; render decisions or elevate appropriately Lead care coordination for members with complex, chronic, or serious illness including proactive outreach, care plan development, and cross-functional coordination with providers, specialists, and facilities Conduct serious-illness outreach for high-risk members identified through claims data, referrals, or internal flags; assess needs, connect to resources, and follow through Apply utilization management principles across inpatient, outpatient, and specialty care; identify gaps, flag outliers, and work with the clinical team to close them Serve as a clinical escalation point for the member support team; take ownership of cases requiring RN-level judgment and resolve them end-to-end Maintain and build knowledge of plan benefits, network configurations, coverage rules, and relevant regulatory requirements (ERISA, state UM standards) Member Support (30%)Field inbound calls, emails, and messages requiring clinical context, coverage questions, care navigation, prescription issues, provider coordination Translate complex clinical and benefit concepts into plain language that members can act on Advocate for members internally; surface friction patterns, propose improvements to product, process, or communications Document every interaction thoroughly and in real time; chart as you go so anyone on the team can pick up where you left off Coordinate across providers, PBMs, pharmacies, HR teams, and claims processors to actually close loops, not just pass messages Using available tools, negotiate cash prices with providers on behalf of members Operations and Automation Build internal tools and automations using AI coding tools (e.g., Claude Code) to reduce manual, repetitive clinical-ops work; scope the problem, take a first pass, hand off to engineering when needed Contribute to SOP development, clinical policy documentation, and quality improvement initiatives

What We're Looking For: The strongest candidates combine clinical credibility with operational horsepower and genuine warmth for members. End-to-end clinical owner. When a complex case lands on your desk, it's yours until it's resolved, not passed to the next queue. You track it, follow through on every thread, and close the loop with the member. Clinical confidence without rigidity. You can make a defensible PA decision, explain it clearly to a provider, and know when to elevate. You know your clinical criteria but you're not a bureaucrat - you see the whole member. Trustworthy and self-directed. You show up, do what you said you'd do, and produce outcomes without constant oversight. We don't need to walk you through each step. We need cases managed, loops closed, and everything charted. Warm and human. Behind every case is someone dealing with something stressful, often frightening. You lead with empathy, listen before you talk, and leave every member feeling like someone with real expertise actually cared about their situation. Privacy-minded. HIPAA is not a rule to follow, it's a trust you keep. You are meticulous about what you share, with whom, and through which channel. AI-curious and automation-minded. You see repetitive clinical-ops work and think about how to eliminate it. You're comfortable using AI tools to draft, research, analyze, and prototype. You don't need to be an engineer; you need to be able to scope a problem and take a first pass. Learning velocity. Benefits administration, plan design, and regulatory nuance are dense. You pick them up fast, ask smart questions, and apply what you learn immediately.

Requirements: Active RN license (required) 2+ years of case management experience - CCM certification preferred but demonstrated case management experience is the threshold Strong clinical foundation with working knowledge of utilization management, prior authorization criteria, and care coordination principles Solid grasp of health insurance fundamentals: deductibles, coinsurance, networks, EOBs, and claims workflow Concrete examples of end-to-end ownership in previous roles Concrete examples of using AI tools to automate or accelerate work; a workflow built, a task automated, a tool prototyped Based in Chicago or willing to relocate; comfortable with a mostly in-office schedule Nice to HaveCCM certification RN license in multiple states Prior auth or UM experience in a TPA, health plan, or managed care setting TPA or self-funded plan background Experience building internal tools with large language models like Claude, Open AI, or similar Experience in a startup or fast-paced environment with a high learning curve Competitive salary and equity options Health, dental, and vision insurance Flexible PTO policy Professional development budget including support for CCM certification or continuing education Equipment budget for your home office setup Regular team retreats and offsites

Interview Process: Our interview process is designed to assess both clinical judgment and operational execution. Application Review Initial Call (45 minutes)with the VP of Clinical Ops and Member Experience - your background, clinical philosophy, and an overview of Nara Simulation Exercise & Team Interview (60 minutes)- work through a real complex case (PA review + care coordination scenario), demonstrate real-time documentation, and walk through how you'd automate a repetitive clinical-ops task - this might include a potential onsite visit to our Chicago office Final Interview (30 minutes)with the CEO to determine mutual fit Nara Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.